The Power of Ultrasound

On top of every cool experience I have had here in Kalukembe, it would not be right without mention of the use of the portable ultrasound. Besides poor quality xray, there are no other imaging modalities available. The Doctors rely heavily on the use of the ultrasound – diagnosing abscesses, endocarditis, free fluid in the abdomen, checking fetal development and even informing a mother coming in for a delivery that she will be bringing home two babies! I have received so much experience with scanning people, which will be so beneficial for my residency training! I was even able to diagnose an ectopic pregnancy!!

Hospital Experiences:

– Common things are common: aka as a medical student I can feel pretty confident in guessing malaria, typhoid or TB for any person who presents wtih fever, fatigue, belly pain and occasionally a cough. This is something very drastic from the pathology in the States. After examining a woman who coughed in my face, her xray confirmed a whopping case of TB. Should be really fun getting my PPD test done upon my arrival to the States. I have seen many children sick with typhoid and malaria, and the success stories bring me such happiness!

– Motorcycle accidents are also common, and so are injuries. They range from road rash to broken bones to comas. The traction used for setting bones is very primative…beams of wood at the end of the bed and bags of sand/dirt used as weight.

– Angolan skin is tough!! I am developing some bicepts trying to suture abdomens closed.

– I am taking part in so many surgeries, which is pretty great. The docs are letting me do more and more, to the point where I was left alone to close up an abdomen the other day. I saw my first typhoid perforation in the OR. When rounding on the little girl the next day, she kept crying out in pain. It then hit me…there are no pain medications here. These children are being so brave. The nursing students are also finding it fun to try and pronounce my name. I usually settle with Emilia, which is easier for them to say.

– The children are adorable and they usually stare at me wide eyed when I examine them…which makes them even more adorable. They are so stoic as they lay in bed with infections and broken bones. Usually the mother is able to sooth the baby with breastfeeding. I am amazed as the family members stay close at all times.

The environment surrounding the hospital is drastically different than what I am used to. First, there are many separate buildings connected with dirt paths. The windows are kept open for air circulation so flies are everywhere. It makes my stomach churn seeing the flies land on infected wounds and fly around peoples faces. The hospital does not provide food or bedding, so family members bring it along. During the day, family members can be found doing laundry and drying them on the lines in the open air. Patients get up and walk around outside. People snoop through open windows and offer their two cents about treatment options. Men and women wards are separate, but consist of large rooms with beds about two feet apart from each other. Women trade holding babies during their examination. Very basic lab work can be done, but can take days to return. Lastly, modesty is not really a concept here. People often are naked in their beds and women breastfeed just about anywhere. I have yet to see a bottle or formula.

The hospital politics are a bit corrupt. The government mandates certain regulations for the hospital and medical care, but then there is lack of support, finances and supplies provided to the people. The sense of obligation and patient advocacy seems to be lacking from the nursing staff. I have been trying to figure if it stems from a cultural mentality or a lack of education. Either way, it is difficult to provide good quality care to the people.  And I thought American Politics were bad….

I had the experience of going to the local market midway through my second week in Kalukembe. It was about a 10 minute drive from the hospital, so I got to see more of the country. The market was a mad-house. Unstable wood structures held new and used clothes (imagine an African Goodwill), bread, plastic tubs for bathing, candies, soaps… you name it. Children followed us around trying to get us to purchase matches or batteries. I successfully purchased my very own pano, which is the fabric that women wrap around their waist and use for practical things such as carrying babies on their backs, wrapping up laundry or sitting on the ground. Look out Ohio, I am going to start a new fashion trend!

And the moment you all have been waiting for…..the thank-you present chicken has finally become a meal. I learned how to humanely kill it, pluck the feathers and prepare it for dinner Umbundu style (the local tribe). And I thought this trip was just going to be about learning new medical knowledge. Bonus!

I do not have much time left in Kalukembe, which makes me realize how quickly time is passing. By the next time I post I will be in Cavango with the Kubacki family, exploring even more rural Angola.

Think I will look like a complete fool wearing my panos to church this coming Sunday? Worth it.


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